The Alabama Medicaid Agency's Program Integrity Division is responsible for planning, developing and directing Agency efforts to identifty, prevent and assist with prosecution of fraud, abuse and/or misuse in the Medicaid program. This includes verifying that medical services are appropriate and rendered as billed, that services are provided by qualified providers to eligible beneficiaries, that payments for those services are correct and that all funds identified for collection are pursued.
The purpose of the division is:
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To guard against fraud, abuse and deliberate misuse of Medicaid program benefits by individual providers and beneficiaries;
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To ensure that Medicaid beneficiaries receive necessary medical care at a level of quality consistent with that available to the general population;
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To assure provider and beneficiary compliance with federal and state Medicaid rules and regulations;
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To assist in the identification of claims processing procedures that may be in conflict with State policy
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Administrative Code - Chapter 4 - Program Integrity Division